Arthroscopic Transtibial Pull-Out Repair of Medial Meniscus Posterior Root Tear With a Whip Running Suture Technique

Kim, Joohwan; Ryu, Dong Jin; Park, Jae Sung; Shin, Tae Soo; Wang, Joon Ho

doi:10.1016/j.eats.2020.11.016

Cited by 12 publications

(12 citation statements)

References 22 publications

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“…Last, patients can experience irritation postoperatively from the tibial fixation, particularly if a screw and washer are used. 4,11,18,19,29 The all-inside meniscus root repair technique represents a less invasive and less technically demanding option for treating MRTs. Nevertheless, there remain potential pitfalls with this technique.…”

Section: Discussionmentioning

confidence: 99%

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A Biomechanical Comparison of All-Inside Versus Transtibial Meniscus Root Repair Techniques

et al. 2023

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Background: Meniscus root tears are associated with chondral injury, early degenerative change, and a high conversion rate to total knee arthroplasty. It is well-established that meniscus root tears lead to decreased femorotibial contact area, increased peak contact pressures, and increased stress on the articular cartilage. Purpose: To evaluate the biomechanical characteristics of the all-inside meniscus root repair procedure and compare it with the previously described transtibial technique. Study Design: Controlled laboratory study. Methods: Nine paired cadaveric knees were prepared by removing skin, subcutaneous tissues, quadriceps muscles, patella, and patellar tendon, while leaving the capsule in place. Pressure-mapping sensors were inserted, and specimens underwent compressive loading to obtain peak pressures, mean pressures, and femorotibial contact area in the medial and lateral compartments. Tests were performed as static compression tests with the knee locked at 0° of flexion. Compression testing was performed in 3 states: meniscus intact, meniscus root cut, and after meniscus root repair with an all-inside repair technique. Additionally, testing was completed on 9 pairs of cadaveric knees to compare stiffness and maximal load to failure between the all-inside and transtibial meniscus root repair techniques. Results: In the medial compartment, there were significant increases in median peak pressures and median mean pressures in the root cut state as compared with the intact state (+636 kPA [95% CI, 246 to 1026] and +190 kPA [95% CI, 49 to 330], respectively). All-inside meniscus root repair restored median peak pressures and median mean pressures to approach those of the intact meniscus (+311 kPA [95% CI, –79 to 701] and +137 kPA [95% CI, –3 to 277]). In the lateral compartment, there were also significant increases in median peak pressures and median mean pressures in the root cut state as compared with the intact state (+718 kPA [95% CI, 246 to 1191] and +203 kPA [95% CI, 51 to 355]). All-inside meniscus root repair restored median peak pressures and median mean pressures such that they were not significantly different from the intact state (+322 kPA [95% CI, –150 to 795] and +18 kPA [95% CI, –134 to 171]). There was no difference between repair techniques regarding load to failure ( P = .896). Transtibial meniscus root repair had significantly more stiffness (mean ± SD, 24.8 ± 9.3 N/mm) as compared with the all-inside meniscus root repair technique (13.6 ± 3.8 N/mm, P = .015). Conclusion: All-inside meniscus root repair reduced median peak and mean pressures to those of the native intact meniscus with the knee in extension in the cadaveric model. When compared with a transtibial meniscus root repair technique, all-inside repair demonstrated decreased stiffness and a similar load to failure. Clinical Relevance: All-inside meniscus root repair restored mean and peak femorotibial pressures to those of the intact meniscus. Additionally, it offers a technically easier technique for management of meniscus root tears.

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Section: Discussionmentioning

confidence: 99%

“…Last, patients can experience irritation postoperatively from the tibial fixation, particularly if a screw and washer are used. 4,11,18,19,29…”

Section: Discussionmentioning

confidence: 99%

A Biomechanical Comparison of All-Inside Versus Transtibial Meniscus Root Repair Techniques

et al. 2023

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“…Despite the acceptable results of arthroscopic transtibial pullout repair in the treatment of posterior meniscal repair, many efforts are being made to further optimize this procedure. For example, Kim et al used a whip running suture technique in arthroscopic transtibial pullout repair to reduce the risk of meniscus cut-through by the suture material and also optimize the reduction of the extruded meniscus 9 . Chen et al introduced a robust pullout suture construct (slip knot technique) to optimize the biomechanical properties of arthroscopic transtibial pullout repair in matching the intact root 12 .…”

Section: Discussionmentioning

confidence: 99%

“…For the control group, the transtibial pullout repair was performed as previously described. 9 For the case group, an orange or gray 14 G angiocath (I.V. Cannula, POONAMIA COMP., INDIA) (Fig.…”

Section: Methodsmentioning

confidence: 99%

Using a simple angiocath instead of scorpion suture passer in transtibial pullout repair of the meniscal root tear

Moghtadaei,

Bagherifard,

Yahyazadeh

et al. 2023

Current Orthopaedic Practice

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Background: Suture pullout during arthroscopic transtibial pullout repair of the meniscal root tear is generally performed using a Scorpion. In this study, we introduce a suture passing technique using a simple angiocath and compare its results with that of a Scorpion. Patients and Methods: In a retrospective series, 28 patients for whom an angiocath was used to pass the suture and 28 group-matched patients for whom a Scorpion was used were included. The outcomes of the patients were evaluated radiologically by assessment of ghost sign, cleft sign, and meniscal extrusion in knee MRI, and clinically by the assessment of the International Knee Documentation Committee (IKDC) score, Lysholm scale, and VAS for pain, which were obtained in the last follow-up. Results: The baseline characteristics of the two groups were not significantly different. After the operation, no patient had a positive ghost or cleft sign. The change of meniscal extrusion was not statistically different between the two groups (P=0.24). At the last follow-up, the mean Lysholm scale was 84.7±7.3 in the case group and 83.7±7.4 in the control group (P=0.61). The mean IKDC score was 84.6±6.8 in the case group and 85.3±4.9 in the control group (P=0.33). The mean VAS for pain was 3.2±0.9 in the case group and 3.3±0.9 in the control group (P=0.44). Conclusion: Using an angiocath to pass the suture in transtibial pullout repair is a cost-effective and efficient substitute for the Scorpion suture passer and could be used alternatively. Level of evidence: Level IV.

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“…For one thing, the horizontal mattress suturing can stabilize medial tissue of MMPRT and PCL. For another, a horizontal mattress suturing method with FAST‐FIX 360° underlying the tibial side of posterior horn of medial meniscus was performed to reduce posteromedial meniscal extrusion 24 . The remaining two sutures of the two horizontal mattress sutures were tied together to reduce medial meniscus extrusion.…”

Section: Discussionmentioning

confidence: 99%

Non‐Anatomical Arthroscopic All‐Inside Repair of Medial Meniscus Posterior Root Tear to Posterior Cruciate Ligament for Patients with Normal Lower Limb Alignment

Jiang

Xing

et al. 2022

Orthopaedic Surgery

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Objective To describe a non‐anatomical arthroscopic all‐inside repair of medial meniscus posterior root tear (MMPRT) to posterior cruciate ligament (PCL) technique for patients with normal lower limb alignment and to evaluate the short‐term clinical and radiologic outcomes. Methods MMPRT directly to PCL was repaired with all‐inside horizontal mattress suturing technique rather than by the transtibial pullout suture technique or anchor suturing repair technique in 20 Laparade Type II MMPRT patients with normal lower limb alignment during 2018–2019. The clinical and radiological outcomes were evaluated retrospectively for at least 2 years follow‐up. The VAS score, Lysholm score, Tegner activity score were evaluated preoperatively and at the final follow‐up. The status of the medial meniscus posterior root were assessed on magnetic resonance imaging (MRI) preoperatively and at the final follow‐up. Results Twenty patients (mean age 54.5 ± 19.5 years) were included in the present study. The mean follow‐up duration was 32.5 ± 5.8 months. The VAS score was significantly decreased from preoperative 6.5 ± 1.5 to 2.1 ± 1.4 at the final follow‐up ( P < 0.01). The mean Lysholm score was significantly improved from 43.7 ± 10.9 preoperatively to 85.7 ± 10.8 ( P < 0.01). The median Tegner activity score was improved from 1.0 (range 1–4) to 3.0 (range 2–4, P < 0.01). On MRI, a total of 12 cases (60%) had complete healing, while eight cases (40%) had partial healing. Conclusion Non‐anatomical arthroscopic all‐inside repair of MMPRT to PCL may yield beneficial clinical outcomes and a higher rate of clinical healing in Type II MMPRT patients with normal lower limb alignment. It is an easy and reliable alternative technique to the transtibial pullout suture or anchor suture repair technique.

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Arthroscopic Transtibial Pull-Out Repair of Medial Meniscus Posterior Root Tear With a Whip Running Suture Technique

Cited by 12 publications

References 22 publications

A Biomechanical Comparison of All-Inside Versus Transtibial Meniscus Root Repair Techniques

A Biomechanical Comparison of All-Inside Versus Transtibial Meniscus Root Repair Techniques

Using a simple angiocath instead of scorpion suture passer in transtibial pullout repair of the meniscal root tear

Non‐Anatomical Arthroscopic All‐Inside Repair of Medial Meniscus Posterior Root Tear to Posterior Cruciate Ligament for Patients with Normal Lower Limb Alignment

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